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When does an underbite need surgery? The short answer is: when Dr. Allen Garai & Dr. Karen Tratensek and our team recommend surgery as the best way to give you a healthy, functional bite. But let’s take a longer look, and see just why your doctors might come to that conclusion.

• First, what exactly is an underbite?

In a perfect bite, the upper and lower jaws align, well, perfectly. Upper teeth overlap lower teeth very slightly, upper and lower teeth meet comfortably, and jawbones and joints function smoothly. When the alignment is off, it causes a malocclusion, or “bad bite.”

When we talk about an underbite, or Class 3 malocclusion, it means that the lower jaw protrudes further than the upper jaw. This protrusion causes the bottom teeth and jaw to overlap the upper teeth and jaw.

• What causes an underbite?

Sometimes an underbite is caused by childhood behaviors while the teeth and jaw are developing, including tongue thrusting or prolonged thumb-sucking and pacifier use. (Working to stop these behaviors before they affect tooth and jaw formation is one of the many good reasons children should have regular visits with their dentists and pediatricians.)

Most underbites are genetic, however, and tend to run in families. It’s estimated that from five to ten percent of the population has some form of underbite. The lower jawbone (mandible) might be overdeveloped, the upper jawbone (maxilla) might be underdeveloped, both bones could be affected, or, sometimes, tooth size and placement might cause an underbite. These irregularities in jaw shape and size and/or tooth crowding are not something that can be prevented, and require professional treatment.

• Why? What’s the problem with an underbite?

Even a minor underbite can cause difficulties with biting and chewing. A more severe underbite can lead to speech problems, decay and loss of enamel where the teeth overlap, mouth breathing and sleep apnea, persistent jaw and temporomandibular joint pain, and self-confidence issues.

• Can’t my dentist treat my underbite?

Most probably not. A very mild underbite can be camouflaged cosmetically with veneers, but this does not address the cause of the underbite, and will not work for moderate or severe underbites.

• Can my orthodontist treat my underbite?

Dr. Allen Garai & Dr. Karen Tratensek will create an underbite treatment plan after a detailed study of each patient’s individual dental and skeletal structure. Treatment options will vary depending on the cause of the underbite, its severity, and even the patient’s age.

Early intervention is especially important for children who show signs of an underbite. That’s why we recommend that children visit our Vienna, VA & Great Falls VA office by the age of seven.

If an underbite is caused by tooth misalignment or crowding, braces can reposition the lower teeth. Sometimes extractions are necessary to make room for proper alignment.

If the cause is due to jaw structure, children’s bones are still forming, so treatment can actually help correct bone development. Palatal expanders, headgear, and other appliances are various methods of encouraging and guiding bone development.

But braces and appliances aren’t effective for every patient with an underbite, and especially in patients (usually those in their late teens and older) when the jawbones are already fully formed. In this case, we might suggest coordinating treatment with an oral and maxillofacial surgeon.

• What does an oral and maxillofacial surgeon do?

An oral surgeon has the training, experience, and skill to help correct an underbite by surgically reshaping and repositioning the jawbone. This corrective jaw surgery is called orthognathic surgery.

• What will happen during orthognathic surgery?

Your treatment will be tailored to your specific needs. Two of the common surgical procedures for treating an underbite involve repositioning the upper jaw to lengthen it and/or reshaping the lower jaw to shorten it.

Bone is sometimes removed or added, small bone plates or screws are sometimes used to stabilize the bone after surgery—your surgeon will let you know exactly which procedures will give you a healthy, functional bite. The surgery itself is most often performed under general anesthesia and requires a brief stay in the hospital.

• How will my orthodontist and oral surgeon coordinate my treatment?

Correcting a Class 3 malocclusion can take time. Your oral surgeon will work together with Dr. Allen Garai & Dr. Karen Tratensek to analyze the interrelationship of teeth, bones, and joints to determine dental and skeletal problems, and will develop the best treatment plan possible to create a healthy alignment.

• So, when does an underbite need surgery?

Sometimes, a minor underbite can be corrected with braces and appliances alone. A serious underbite, however, will often require the specialized skills of both Dr. Allen Garai & Dr. Karen Tratensek and an oral surgeon.

And, while it’s not the primary purpose of surgery, corrective jaw surgery and orthodontics can also make you happier with your appearance and boost your self-confidence. Achieving a lifetime of beautiful, comfortable, and healthy smiles—that’s the answer to your question.

No matter how careful you are, accidents can happen. Perhaps it’s a slice of apple that was a little bit larger than it should have been. Or you were chewing on your pencil while you were trying to work out an algebra problem. Or you tried a piece of candy that your friend really, truly thought didn’t have a caramel center.

No matter the cause, when something‘s wrong with your braces, you know it. And you want to fix it as soon as possible. What can you do to make yourself more comfortable? And which repairs are best left to orthodontic professionals?

First things first. If you have been injured, and suffered a trauma to your mouth or jaw that has damaged your braces, we want to make sure that you get any medical attention you might need before we worry about your appliance. Call Dr. Allen Garai & Dr. Karen Tratensek, and your doctor, immediately if you have suffered a medical or dental injury.

Even if your braces are the only injured party, you might need a special appointment if the damage is something that shouldn’t wait and can delay your orthodontic progress. Broken wires, brackets that have fallen off, and loose orthodontic bands, for example, need to be replaced in our office.

But what about minor problems? First, call us to see if it’s something that really is minor, and whether you can do some home repairs to keep you going until your next regular visit.

• Wayward Wires

One of the most common—and most annoying—problems is a broken or out-of-place wire. If a wire end is poking you, dental wax can be applied to the loose end to protect your cheeks and gums. If that doesn’t work, we can let you know how to apply gentle pressure to move the wire away from delicate tissue. Don’t try to cut a broken wire or remove it without talking to us—small pieces can be swallowed accidentally. We’ll give you suggestions for how to handle a broken or loose wire and protect your mouth until you can see us.

• Breakaway Brackets

If your bracket becomes loose, this is another good reason to give us a call. Brackets are specifically placed to let your archwire guide your teeth where they need to be. Without a firmly bonded bracket, the wire isn’t doing you much good! If a loose bracket is irritating your cheeks or gums, you can try a bit of dental wax to stick it in place and cover hard edges until we can re-bond it. If the bracket comes off all together, bring it with you to your next appointment.

• Balky Bands

Spacers are little rubber bands we put between your teeth if we need to create some room between your molars before you get your braces. They have a tendency to fall out after several days. We’ll let you know if their work is done, and you’re ready to start your orthodontic treatment. If you lose one of your ligatures, those colorful bands around your brackets, give us a call and we’ll let you know if replacement can wait.

We’re happy to help you with any braces problems, large or small. It’s best to check with us for even small fixes to make sure you avoid injury. Larger repairs can be handled in our Vienna, VA & Great Falls VA office—and we can give you tips on how to prevent future ones. Accidents happen, but they don’t need to delay your progress toward a beautiful, healthy smile.

If your child has just gotten braces, chances are it’s a good time to brush up on dental hygiene! Why now? What’s different? And how can you help? Let’s take a few minutes and explore these timely questions.

Brushing and Flossing Are Especially Important with Braces

There’s no getting around it, it’s harder to clean teeth with brackets and wires. But it’s essential to pay attention to dental hygiene. When bacteria and plaque start building up, your child is at risk for gum disease, cavities, and tooth discoloration.

• Gingivitis

This early stage of gum disease is the result of gum irritation caused by plaque. The gums become red, swollen, sore, and can bleed or start to recede. With proper brushing and flossing, gingivitis can be eliminated, along with the risk of developing more serious gum disease.

• Tooth Decay

One of the major reasons for cavities is the erosion of enamel caused by oral bacteria. These bacteria feed on sugars from our diet and produce acids that attack the tooth’s surface. Plaque, formed by a mass of these bacteria, sticks around brackets and the gum line, putting your child at risk for cavities near his orthodontic work—which might require removing wires and brackets to treat.

• Demineralization

When acids attack teeth, they remove the minerals from our enamel. This demineralization eventually leads to cavities, but in its early stages can cause white spots to appear where the mineral structure has been weakened. Braces wearers are at special risk for demineralization, especially around brackets and near the gums, where plaque can be missed while brushing.

Time for New Brushing and Flossing Techniques

Even if your child has always done a wonderful job of brushing and flossing, braces provide a new challenge for getting teeth their cleanest. Unfortunately, plaque buildup around the brackets and the gum line is all too common in orthodontic patients. Dr. Allen Garai & Dr. Karen Tratensek can recommend some tools that make the cleaning process easier and more effective.

• Toothbrushes

Manual brushes are available with small, soft-bristled heads designed especially for braces wearers. If your child still has problems getting rid of plaque and food debris, an electric toothbrush might be helpful. And remember, encourage your child to be thorough but gentle for the sake of both braces and gums.

• Flossing with Braces

Flossing can be challenging for children at any time, but especially with braces. We’ll show you how floss threaders work, and how special flosses designed just for braces can fit under wires. This might also be a good time to invest in a water flosser. Your help demonstrating how to floss even with brackets and wires blocking the way will be appreciated by your child and your dentist!

• Products Just for Braces

Interproximal brushes are tiny cone-shaped brushes designed to fit around brackets and wires and between teeth. We can also suggest special toothpastes and rinses to help fight plaque and prevent cavities from developing. Ask us about what to shop for to make both of your lives easier.

You Can Help!

• Teamwork—Works!

When your child first gets braces, practice brushing and flossing together. Our Vienna, VA & Great Falls VA team will be happy to show you both the very best techniques for keeping teeth their cleanest and healthiest. Especially for young children, your help will make sure those techniques are learned and used.

• Make Time for Cleaning

Your child’s before-braces routine might have meant brushing two minutes each morning and two minutes at night. But thorough cleaning around brackets and wires might take a bit longer. (And, with braces, it’s best to brush after every meal rather than the common twice-a-day routine). Be available, at least at first, for a quick check to make sure braces and teeth are their cleanest. And you may have to help with removing and replacing bands until your child gets the hang of it.

• Be Prepared!

Whether it’s a day at school or an overnighter with friends, be sure your child has a kit filled with cleaning supplies ready to take along. A toothbrush, floss, an interproximal brush, toothpaste, a mirror—with these necessities, your child can keep on top of any cleaning emergencies.

For younger children especially, learning how to keep teeth and braces their cleanest can take some time. Be patient, be prepared, and be willing to help, and you and your child will have a new routine mastered—in no time at all!

The weather out there might be frightful for most of us, but not for you! You’ve been waiting all year for a fresh coat of powder and all the outdoor sporting activities winter brings. But before you grab those ski poles, strap into that snowboard, lace up those skates, or dust off that sled, be sure to remember one more essential piece of gear—your mouthguard!

Mouthguards aren’t just for contact sports. While all that lovely new snow looks like powder, it doesn’t feel like it when you land hard. If there’s a chance of a fall or an impact in any sport, there’s a chance you can suffer dental injuries.

Falls or collisions can result in chipped, broken, or dislodged teeth. Your mouthguard will help protect your smile from these accidents, and also works to protect you from biting your tongue and mouth in case of impact. It can even reduce the chance of jaw injuries.

Luckily, finding a mouthguard that works for you is even easier than finding the perfect board or the best wax for your skis. You have several options to choose from:

• Ready-made appliances. These are available in drugstores and sporting goods stores, but come in pre-formed sizes, so they might not provide the best fit.
• The “boil-and-bite” model. This mouthguard form is placed in hot water. You then bite down while it is pliable to shape it to your mouth and teeth.
• Custom mouthguards. These guards can be fabricated just for you. They are molded to fit your individual mouth and teeth, so provide a better fit and better protection. They are also usually more durable and more comfortable. If you wear braces, a custom mouthguard can be your best option for preventing an injury to your mouth and your braces. Talk to Dr. Allen Garai & Dr. Karen Tratensek if you are interested in a guard fitted specifically for you.

When you visit our Vienna, VA & Great Falls VA office, let’s discuss all the best ways to keep your teeth and mouth protected before you set out for winter sports. And then when you’re ready to go? Let it snow!